Efficacy of an aloe vera, chamomile, and thyme cosmetic cream for the prophylaxis and treatment of mild dermatitis induced by radiation therapy in breast cancer patients (the Alantel study).

Objectives: Radiation-induced dermatitis (RD) is one of the most common toxicities in radiation therapy (RT) patients. Corticosteroids, immunosuppressants, and natural products (NPs) have been used as treatment. The objective was to evaluate the efficacy of a NPs-based cream (Alantel®) to reduce the incidence of RD in women with breast cancer undergoing RT treatment. Design: We conducted a controlled, randomized, double-blind clinical trial. Setting: Radiation Oncology Unit of the Reina Sofía Hospital and 5 Primary Care centers of the Cordoba and Guadalquivir Health District (Spain). Interventions: Patients assigned to the experimental group (GTA) were treated with Alantel, while those in the control group (GTE) were treated with a moisturizer and emollient cream. Main outcome measures: The primary outcome variable was the incidence of RD. RD-free time, duration of RD, quality of life, and product safety were also assessed. Results: Seventy patients were included in the study, 35 in the GTA and 35 in the GTE. The incidence of RD was lower in the GTA (71.4%) than in the GTE (91.4%) after 4 weeks of follow-up (RR = 0.78; NNT = 5; p < 0.031). The Skindex-29 questionnaire showed differences in the statement: "My skin condition makes it hard to work or do hobbies" (17.1% in the GTE vs. 2.9% in GTA; p = 0.024). Conclusions: The higher efficacy of Alantel® compared to the control cream in reducing the incidence of RD in women with breast cancer has been demonstrated.

[Hypothyroidism in adults in a basic health area]. / Hipotiroidismo adulto en una zona básica de salud.

INTRODUCTION: The objective of the present study is to study the prevalence, as well as the clinical and epidemiological characteristics of hypothyroid disease in adults using the computerised clinical records. MATERIAL AND METHODS: Observational, descriptive and cross-sectional study. The target population was the patients of the health centres of Lucena I and II (Córdoba). INCLUSION CRITERIA: Patients 14 years or older, diagnosed with hypothyroidism, born and resident in Lucena. Two hundred and fourteen patients were recruited by random sampling, who then underwent a clinical interview using a questionnaire. RESULTS: The mean age of the patients was 49.71 years (SD 17.03; 95% CI 47.34-51.98), with 85.5% women. A diagnosis of sub-clinical hypothyroidism was found in 74.8%, compared to 18.7% of primary hypothyroidism, and 6.5% of secondary hypothyroidism. The 53.7% (95% CI 46.81-60.59) of patients diagnosed with hypothyroidism did not have thyroid antibodies results. However, 75.2% (95% CI 68.89-80.86) were being treated with levothyroxine. The prevalence of hypothyroidism was 5.7% (95% CI 5.46-5.96). CONCLUSIONS: Sub-clinical hypothyroidism is very common in Primary Care clinics. Many patients are not correctly diagnosed and many are over-medicated, suggesting a need to review the diagnosis.

[Validation of taking arterial pulse in Primary Care for the detection of atrial fibrillation and other cardiac rhythm disorders in patients over 65 years old]. / Validación de la toma del pulso arterial en atención primaria para la detección de fibrilación auricular y otros trastornos del ritmo cardiaco en mayores de 65 años.

INTRODUCTION: Atrial fibrillation (AF) is the most frequent arrhythmia in clinical practice and has important prognostic implications. The objective of this study was to demonstrate the validity and the reliability of taking the arterial pulse (TAP) in patients over 65 years for detecting in AF and other rhythm disorders. MATERIALS AND METHODS: A descriptive, observational, multicentre study to validate a diagnostic test within in a controlled clinical trial. SETTING: 39 Primary Care Centres in the Spanish National Health Service. A total of 318 physicians and nurses took part in the analysis of validity, and 166 of them took part in the analysis of reliability. The professionals were previously called to a meeting in which they took the arterial pulses, and were given 4 ECGs to interpret. The participants TAP of 864 patients followed by an ECG to confirm the cardiac rhythm. Sensitivity, specificity and predictive values were estimated to assess the criterial validity and the simple concordance index to check reproducibility. RESULTS: The sensitivity of pulse measurement for detecting AF detection was 99.4% (95% CI: 97.9-100.0), with a specificity of 30.7% (95% CI: 26.1-35.3), a positive predictive value of 36.6% (95% CI 32.0-41.2), and negative predictive value of 99.2% (97.3-100.0). The simple concordance between the researchers and the cardiologist for the ECG diagnosis of AF ranged between 84.9% and 91.6%. CONCLUSIONS: The TAP has a high sensitivity but a low specificity to detect AF. It is a reliable test for the opportunistic screening of arrhythmias in patients aged over 65 years.

[Prevalence and factors associated with peripheral artery disease in patients with type 2 diabetes mellitus in Primary Care]. / Prevalencia y factores asociados a la enfermedad arterial periférica en pacientes con diabetes mellitus tipo 2 en Atención Primaria.

INTRODUCTION: Peripheral artery disease in the lower limbs (PAD) is a prevalent condition that entails high morbidity in diabetic patients; this study assesses PAD in these patients and its socio-demographic and clinic associated variables. MATERIAL AND METHODS: Descriptive study in a systematic sample of diabetic patients (DM2) aged 50-80 years, in Primary Care settings. The dependent variable was the presence of PAD diagnosed by ankle-brachial index (ABI) ≤ 0.9; independent variables: socio-demographic, clinical and laboratory. STATISTICS: bivariate and multiple logistic regression analyses were performed to determine the variables associated with low ABI. RESULTS: A sample of 251 patients, 52.6% women; mean age: 68.5 ±8.5. A low ABI was detected in 18.3% (95% Confidence Interval (95% CI):13.3-23.3%), with 6 subjets (2.4%) previously diagnosed as suffering PAD. Age (OR=1.07; 95% CI: 1.02-1.12) and retinopathy (OR=2.69; 95% CI: 1.06-6.81) were associated (multiple logistic regression analysis) with ABI. CONCLUSIONS: The percentage of patients diagnosed with PAD is very low, although PAD prevalence is high among DM2 patients attending Primary Care clinics, especially in older patients and those with retinopathy. We emphasize the recommendation of performing the ABI test in this population at risk.

Prevalence of renal stones in Andalusian population: results of PreLiRenA study.

INTRODUCTION: Urolithiasis is a disease having a high recurrence rate and associated morbidity. A not well quantified increase is being seen in recent years that could be related with various factors. The main purpose of our study has been to estimate urolithiasis prevalence and incidence in the region of Andalusia, determining which factors are associated. MATERIAL AND METHODS: We performed an observational and cross-sectional study. Using a multistage randomized procedure, we selected a sample of 2439 subjects, aging from 40 to 65 years old, who currently lived in Andalusia. Data was collected through phone interviews, questioning the chosen subjects about their kidney stones history, comorbidity and socio-demographic characteristics. We conducted a descriptive, bivariate and multivariate analysis with logistic regression. RESULTS: A total of 2439 subjects were surveyed. Subjects had mean age of 51.1±7.61 years - standard deviation; (95% confidence interval - 95% CI: 50.70-51.30), 48.7% of whom were male. Prevalence of urolithiasis obtained was 16.4% (95% CI: 14.87-17.85%) and an incidence of 1.2 (95% CI: .74-1.64). Variables significantly associated with the presence of urolithiasis found in the multivariate study were: presence of a family history of kidney stones (odds ratio -OR: 1.91; 95% CI: 1.51-2.40, P<.001), hypertension (OR:1.58; 95% CI:1.24-2.02; P<.001), gout (OR:1.98; 95% CI: 1.26-3,12; P=.003) and a high BMI (OR: 1.60; 95% CI 1.19-2.17; p=.008). CONCLUSIONS: A significant increase in the prevalence and incidence of urolithiasis is observed in the environment in regards to the previously available figures. The presence of a family history of urolithiasis, hypertension, gout as well as having a high BMI could influence the observed epidemiological changes in renal lithiasis.

[Identification of problems and needs in health: description of a participative experience in primary care]. / Identificación de problemas y necesidades de salud: descripción de una experiencia participativa en atención primaria.

OBJECTIVE: To identify health problems and needs from a Health area population. To detect inequalities in relation with sociodemographic variables. METHODS: An observational descriptive study, cross-sectional study, qualitative research. SETTING: A Health area in Cordoba divided in three different areas: residential, inner city and rural area. We select three different groups of population and the following instruments of measurements: a) general population older than 15 years old (survey by interview completed door-to-door and personally) (N = 12,801) (coverage = 96.6%); b) Representatives of the community (N = 47), by Delphi technique (answering rate = 62.5%) and Nominal Group technique applied to participants in Health Councils (answering rate = 65.4%); c) Health workers (N = 45), by Delphi Process (answering rate = 58.5%). RESULTS: The people consider pains in their joints and allergies as the priority health problems, for the representatives of the community and the health workers the most important problems were dental hygiene and some chronic diseases. The needs detected as most important were, for the people from residential area, the lack of public gardens and cultural sites, for people from the inner city area it was the lack of public safety and in the rural area it was the lack of proper health resources. CONCLUSIONS: Although the different groups we study maintain a close agreement on what are the most important health problems and needs, we observed several interesting disagreement that could be explained by the different point of view that each group has on the process of health-disease, on perceiving problems and needs and on the sociodemographic differences among them.

[Evolution in consumption of and attitude towards tobacco towards physicians at the regional hospital "Reina Sofía," Córdoba]. / Evolución del consumo y actitud ante el tabaco de los médicos del hospital regional "Reina Sofía, Córdoba.

OBJECTIVES: to study the evolution of the smoking prevalence and the personal attitudes about smoking among doctors of a university hospital. MATERIAL & METHODS: cross-sectional study. A survey. Study population was all physicians working in "Reina Sofía" University Hospital of Cordoba (N=738). By systematic sampling we select a random sample of 250 especialist physicians. We designed a self-administered questionnaire with items measuring the prevalence of smoking, the brand they used, the degree of smoking dependence, and their opinion about the new anti-smoking law. We also study the measures for smoking cessation that doctors considered most useful. We compared our data with other similar study carried out in 1987. RESULTS: the prevalence of tobacco use was 42% (CI:95%: 35.5-48.9), below the figure we obtained in 1987 (56.3%; p < 0.001). Doctors between 36-45 years had the highest rates of tobacco consumption (p < 0.01). 86.9% of smokers thought that smoking was unhealthy and among these 83.3% accepted the risk derived of smoking. 86.7% of smokers used to smoke inside the hospital. 86.8% of doctors thought that the new public places restrictive smoking law must be implemented. Doctors smoke more often (68.5%) when they are on call and 26.4% of them recognize to smoke when they inform the patient's family. CONCLUSIONS: we highlight a reduction of the prevalence of smoking among this kind of physicians. We still consider important the high number of physicians which smoke inside the hospital, although this figure have significantly decreased.

[Tobacco consumption among the student population. Related factors]. / Consumo de tabaco entre la población escolar. Factores relacionados.

OBJECTIVE: To know smoking prevalence among schoolchildren and factors related with this habit. METHODS: A cross-sectional study. 548 school-children in their 6th and 8th years of primary studies at schools from an area of Córdoba (Spain) were interviewed. INTERVENTIONS: Autoadministered questionnaire. RESULTS: Tobacco was tried in 22% (CI 95%: 18.7-25.8) school-children. The average age for starting with this habit was 11.6 (SD)(CI 95%: 11.4-11.8). 12.1% smoked regularly and 1.3% smokers every day. The tobacco consumption in children was related with age (OR = 2.96; CI 95%: 1.12-7.82), cough medicines consumption (OR = 3.15; CI 95%: 1.32-7.48), to have a smokers sister (OR = 2.53; CI 95%: 1.06-6.00) and best friend (OR = 4.42; CI 95%: 1.85-10.60) and drinking beer (OR = 3.68; CI 95%: 1.15-11.7). CONCLUSIONS: The prevalence of smoking in our school-children is very close to that reported by others. Among the factors accounted with the tobacco consumption in schoolchildren, highlight the presence of this habit in the eldest sister and the best friend.

[Migraine prophylaxis with calcium antagonists: a haemodynamic study using transcranial Doppler ultrasound]. / Profilaxis de la migraña con antagonistas del calcio: estudio hemodinámico mediante Doppler transcraneal.

INTRODUCTION: Despite its widespread use, a good explanation for the mechanism of action of calcium antagonists (CA) in the prophylaxis of migraine has still not been proposed. AIMS: To determine whether nicardipine and flunarizine therapy is capable of inducing changes in the brain haemodynamics of migraine sufferers that lend support to a vascular mechanism of action for these drugs, as evaluated by transcranial Doppler ultrasound (TCD). PATIENTS AND METHODS: We present a prospective, descriptive study based on observation conducted in a Neurology outpatients department. Patients between the ages of 16 and 50 with migraine (following IHS criteria) who were being treated with nicardipine and flunarizine as a prophylactic measure and did not fulfil any of the exclusion criteria were selected consecutively. The TCD study was performed before and during treatment with CA (flunarizine or nicardipine), for a minimum of one month. The following haemodynamic variables were determined: mean speed, Gosling's pulsatility index and cerebrovascular reserve, determined by the breath holding index. Pre and post-prophylaxis variables were compared using the Wilcoxon signed rank test. RESULTS: Eight patients with migraine were included in the study and no significant differences in any of the three haemodynamic variables were observed between the values obtained prior to or during treatment. CONCLUSIONS: The absence of haemodynamic changes in TCD does not lend support to a vascular mechanism of action for CA in migraine.

[Mean velocity and pulsatile index in primary headaches]. / Velocidad media e ndice de pulsatibilidad en las cefaleas primarias.

INTRODUCTION: Several authors have used transcranial Doppler studies (DTC) in the study of changes occurring in migraine. They found an increase in mean velocity (VM) as compared with controls. However there are few studies of this in tension headache. OBJECTIVE: To determine possible differences in VM and pulsatility index (IP) between patients with migraine and those with episodic tension headache by means of DTC. PATIENTS AND METHODS: We studied 26 patients with migraine, 30 with episodic tension headache (criteria of the IHS) and 21 controls using DTC (Multi Dop P/TCD DWL). We determined the VM and IP of the middle cerebral arteries at a depth of 50 60 mm. Uni bivariate statistical analysis was done using the computer programme SPSS. RESULTS: The VM were: 75.92 cm/s in migraine; 65.96 cm/s in episodic tension headache and 72.28 cm/s in the control group (the differences were not statistically significant: NS). The IP were: 0.80 in migraine and 0.76 in control and tension headache groups (NS). No differences were found either when the VM of migraine and tension headache were compared directly (p=0.067). The theoretical number of patients necessary for a study with results giving statistically significant tendencies was calculated as 44 in each group. CONCLUSIONS: 1. No statistically significant differences were found, probably due to lack of statistical power, since the migraine group showed a tendency to a higher velocity. 2. Further studies on larger numbers of patients are necessary to evaluate the differences between migraine and episodic tension headache.

[Cerebrovascular reactivity by means of the breath holding index (voluntary apnea): the reliability of early repetition]. / Reactividad cerebrovascular mediante el índice breath holding (apnea voluntaria): fiabilidad de la repetición precoz.

INTRODUCTION: The Breath Holding Index (BHI) is a non-invasive method for evaluation of cerebrovascular reactivity, the results of which correlate with those obtained by using intravenous acetazolomide and CO2 inhalation, so that it can be used as an alternative method to these in cooperative patients. However, the technique is not completely defined. Therefore Markus et al make a second measurement of the BHI 2-3 minutes later and take the arithmetical mean of the two readings as the final result. OBJECTIVES: To assess the intra-observer concordance between two BHI obtained with less than two minutes difference, and therefore whether the second index obtained may be used as an indicator of cerebrovascular reactivity. PATIENTS AND METHODS: Our study included 18 patients (7 men and 11 women; average age: 28.8 years; limits 17-50 years) with primary headache and no known cerebrovascular disease, diabetes mellitus or arterial hypertension. Using transcranial Doppler 28 measurements of the BHI (BHI1) were made in the middle cerebral arteries (right and/or left) in a similar way to that described by Markus. Once the average arterial velocity returned to basal levels the procedure was repeated in the first two minutes (BHI2) after the first index. Statistical analysis was done using the Student's t test and the kappa index between the two BHI after taking 0.8 as the cut-off point. RESULTS: The BHI2 (average +/- DT: 0.79 +/- 0.34) was significantly lower than that of BHI1 (average +/- DT: 1.04 +/- 0.44) (p < 0.005, t = 3.683). The kappa index between the two indices was very low: 0.058 +/- 0.158. CONCLUSION: The BHI2 is not a reliable index of cerebrovascular reactivity since it under-estimates it in relation to the previous index, even when the average arterial velocity has returned to basal levels.

[Prevalence of physical activity in relation to variable socio-demographic conditions and life style in Cordoban students]. / Prevalencia de actividad física y su relación con variables sociodemográficas y ciertos estilos de vida en escolares Cordobeses.

BACKGROUND: Regular physical exercise is not a widespread habit among the population. Early childhood in a crucial stage for acquiring this habit. The objective of this study was that of ascertaining the behavior of school-age children with regard to the degree of physical activity they do and to examine the factors involved. METHODS: An observational study was conducted by means of a survey based on a questionnaire which 6th and 8th grade students in a Basic Health Care District of Cordoba (N-585) filled out on their own. Questions were asked regarding the frequency of exercise, preferences and prospects for practicing sports, the children's physical shape and school physical education classes, in addition to other behavior comprising their lifestyles. A dual-variable (p .05) and a multiple-variable analysis was conducted employing logistic regression. RESULTS: A total of 548 students filled out the survey (response rate = 97.8%). 79.3% (IC95% 75.7-82.6) were involved in extracurricular physical activities, 21.0% (IC95% 17.1-24.7%) being involved in intense physical exercise. 50.5% (IC95% 46.3-54.8) did not think that they were in good physical shape. The age, sex, type of residence, the involvement in sports on the part of their parents or a close friend and what they considered their degree of healthiness to be comprised the variables quite strongly linked to doing exercise (p .001). CONCLUSIONS: The prevalence of physical exercise is high, although it progressively decreased with age, especially for girls. A major number of students considered themselves to be in unsatisfactory physical condition.

[Alcohol consumption among students in a basic health area in Córdoba]. / Consumo de alcohol entre los escolares de una zona básica de salud de Córdoba.

BACKGROUND: To determine alcohol consumption amongst schoolchildren, and to discover the factors which are associated with the said consumption. METHODS: A cross-sectional study, by means of a health questionnaire administered to 548 schoolchildren in the 6th and 8th years of Primary Education (EGB) in schools within the Basic Health Area of Cordoba, with a median age of 12.4 years old (limits at 10 and 15 years old). Data were gathered on the consumption of alcohol by schoolchildren and in their social environment, as well as other variables in the lives of schoolchildren. RESULTS: 43.7% (interval of confidence at 95% -IC95%: 39.4-47.9) have tried alcohol, 3.8% (IC95% 2.5-5.9) drink regularly, while 26.8% (IC95% 23.2-30.8) drink occasionally. By means of logical regression analysis we found a connection between the consumption of alcohol and increasing age (Odds Ratio -OR: 0.83; IC95% 0.07-0.98), being male (OR: 1.78; IC95% 1.16-2.73), the consumption of alcohol by older brothers or sisters (OR: 2.25; IC95% 1.35-3.75), the consumption of medicines to treat nervousness (OR: 5.33; IC95%: 1.26-22.5), poor educational performance (OR: 1.002; IC95% 1.0-1.005), the consumption of tobacco (OR: 4.55; IC95% 2.4-8.61) and the feeling of loneliness (OR: 1.41; IC95% 1.01-1.97). CONCLUSIONS: Although the number of schoolchildren who try alcohol is low in comparison with other areas, the percentage of current drinkers is very similar. It would seem that older brothers and sisters have an important influence on starting consumption. The profile of a school age child who drinks corresponds to a male, a smoker, and having feelings of loneliness.

[Knowledge about AIDS and sexually transmitted diseases among adolescents]. / Conocimientos de los adolescentes sobre el sida y las enfermedades de transmisión sexual.

OBJECTIVE: To determine knowledge about AIDS and sexually transmitted diseases (STD) among school adolescent in order to define their lacks, and those aspects to include in programs of health education. DESIGN: Cross-sectional study. SETTING: Secondary schools from Córdoba. PARTICIPANTS: 893 teen students. Stratified random sample. MAIN MEASUREMENTS: Anonymous self administered survey. Dates related with knowledge about AISD, STD and its mechanism of transmission. MAIN RESULTS: The mean age of the sample was 17.16 years (95% CI, 17.05-17.26) and 48% was men. 56.7% (95% CI, 53.46-59.94) recognize to be very informed about AIDS and STD, finding significant differences among public (58.9%) and private schools (51.6%) (P=.045). About AIDS, the mean of successes was 8.81 (95% CI, 8.69-8.92; limits 0-12), finding positive differences among men (P=.048); older students (P=.003); public schools (P=.025), and the students non believers (P=.021). About STD, the mean of successes was of 2.47 (95% CI, 2.35-2.78; limits 0-12), with significant differences among women (P=.045); older students (P=.001) and public schools (P=.001). About AIDS sexual transmission, the mean of successes was of 13 (95% CI, 12.87-13.12; limits 0-16), without differences between sex, classrooms or type of schools. CONCLUSIONS: Level of knowledge shown by adolescents for aspects related to STD is poor. Likewise, the information about AIDS can be consider as enough, being men those that to present a bigger degree of knowledge.

[Food consumption patterns among adolescents]. / La alimentación en el adolescente.

BACKGROUND: Adolescence is a critical time for the establishment of healthy eating habits. The objective was to analyze food consumption patterns among adolescents and their relationship with family and social factors. METHODS: Multicentre observational cross-sectional descriptive study using a food frequency questionnaire for the last week. It was answered anonymously. The adolescent's age/gender, parents' studies/occupation and school's location/type were included. The population sample was composed of 1,095 adolescents in sixth grade at primary schools from an Andalusian region. They were chosen by polietapic random sampling that distinguished between public/private and capital/provincial schools. RESULTS: 1,005 surveys were analyzed. The mean age is 11.45 (SD: 0.59). Fifty-three percent were male. The intake of dairy products (only two-thirds taken daily), pasta, fruit and vegetables (daily consumption of 30%) is deficient. Sixty-four point five percent consume legumes weekly. Fish consumption is equal to meat, with a preference for poultry. More than half consume red meat daily. Olive oil is preferred. The intake of "empty calories" (fast food, candies, soft drink) is high. Through multivariate analysis the existence of clusters of healthy and unhealthy foods, related to the social status of the parents and the type of school, is proved. CONCLUSIONS: A healthy diet based on the nutritional pyramid is not the consumption pattern in the adolescents surveyed. There is a low consumption of diary products, legumes, fruits and vegetables. There is a relationship between the social class of the family and consumption patterns (healthy and unhealthy). Health strategies are needed to modify such inappropriate consumption.

[Patients' perception on attention received from Health Centres non-sanitary staff]. / Percepción de los pacientes sobre la atención recibida por el personal no sanitario en los centros de salud.

AIMS: To know patients' perceptions about relational aspects and technical procedures when they are attended by the administrative staff in Health Centres. To assess the utility of two ways for measuring satisfaction. MATERIAL AND METHODS: Cross-sectional study carried out in people attending the administrative sections of Health Centres for diverse reasons. Just after the interaction with the administrative they were interviewed using two different questions for assessing their opinions and satisfaction with communicational and technical aspects related with their demands. Descriptive analysis. Significant differences among mean was explored by χ(2) test. Open-ended questions were grouped in categories in a process involving three researchers independently. RESULTS: Over than 90% (360) of the attendees declared to be satisfied or very satisfied with the service received from the staff personal. Nevertheless, among 18-36% gave suggestions for improving the service after their consultation. Independently the domain explored, people suggested the communicational, personal capability, quality and quantity of explanations and waiting time as the main aspects to be improved. CONCLUSIONS: Surveys with open-ended questions are more useful to assess the quality of the attention the citizens receive from no-sanitary staff in Health Centres. These type of questions are also more useful for detecting problems and planning new interventions. Relational and informative issues seem to be the most prioritary areas to improve in this section of Health Centres.

[Opinions of health professionals on the impact of the Preventive Activities and Health Promotion Program (PAPPS)]. / Opiniones de los profesionales sanitarios sobre la influencia del Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS) en atención primaria.

OBJECTIVE: To find out the opinion of Primary Health Care (PHC) professionals on the impact of the Preventive Activities and Health Promotion Program (PAPPS). DESIGN: Descriptive qualitative-quantitative study. In a first phase the SWOT technique was used. In a second phase a 47 item questionnaire was designed using an ordinal scale. PARTICIPANTS: Professionals of PAPPS health centre, PAPPS managers and PHC management, using the Autonomous Community, and the time of ascribing or knowledge of PAPPS as segmentation criteria. In the qualitative study 62 participants were selected by theoretical sampling. In the quantitative study, 198 professionals took part in the survey. PRINCIPAL MEASUREMENTS: The assessment of the results has taken into account the responses to the questions formulated and by performing a crossed analysis between strengths/threats and weaknesses/opportunities. A descriptive statistical analysis of the questions in the questionnaire. RESULTS: There is agreement in that PAPPS has greatly influenced the development of PHC, contributing to improving the quality of care, but it is also fundamental to try revitalise the programme, as the limited involvement by the professionals in the postulated preventive recommendations is its main weakness, due to lack of motivation and professional burn-out.. CONCLUSIONS: According to the participants PAPPS has contributed significantly to the development of PHC in our country and has had an influence on professional practice by instilling a prevention culture that hardly existed before.

[Validity and reliability of a tool for assessing clinical communication in consultations: the CICAA questionnaire]. / Validez y fiabilidad de un instrumento para evaluar la comunicación clínica en las consultas: el cuestionario CICAA.

OBJECTIVE: To assess the validity and reliability of a tool for evaluating the clinical communication skills of health professionals. DESIGN: Descriptive study of the validation of a tool. SETTING: Primary and specialist care. PARTICIPANTS: Twenty communication experts, in 31 interviews with patients seen by real and standardised nurses, primary care, and specialist doctors, residents with acute and chronic patients. INTERVENTIONS: The study looked at a 36-item, multidimensional evaluative scale on 3 levels, based on the CICAA theoretical model of an interview and examined: 1) its apparent validity, consensus, and content: the clinical communication experts made 2 assessments, a qualitative one and one to weigh the importance of the remaining items; 2) its internal consistency and intra-observer reliability. An expert evaluated 31 interviews, video-recorded on 2 occasions with a 1-to-2 month interval. RESULTS: A 29-item scale was obtained. Cronbach's alpha was 0.957 (95% CI, 0.932-0.976). The overall Intra-class Correlation Coefficient was 0.967 (95% CI, 0.933-0.984). The Kappa values of the items were <0.4 in 3, 0.4-0.6 in 6, 0.6-0.8 in 14, and >0.8 in 4. CONCLUSIONS: The CICAA is a valid and reliable questionnaire for evaluating the clinical communication between various health professionals and patients.